Pharm 3 quiz Flashcards
c diff symptoms (C, it’s watery)
watery diarrhea, abdominal pain, fever. **Gas pain. can only be cleaned with bleach.
c diff cause
antibiotics disrupt normal gut microflora causing an overgrowth of c. diff
vaginitis causes
tetracycline, normal vaginal microflora is disrupted and overgrowth. Superinfection.
treatment for crystalluria
increase water to 2000 to 3000 mL/water in 24 hrs. IV fluids. Check breath sound before giving water.
crystalluria is caused by
sulfonamides
cillin allergic reactions (and what percentage) (penicillin is a ute that has hives)
0.7 - 4%. Urticaria (hives), pruritus, angioedema (swelling underneath the skin) anaphyalactic .0004% rare
cross-sensitivity to Cephalosporin
potential cross-sensitivity to penicillin if true allergy exists.
Cephalosporin drug interactions (NOT penicillin - this is interactions) and take with what?
alcohol, antiacids, iron, probenecid, contraceptives. (take with food)
tetracycline avoid
milk and cheese.
tetracycline s/e
teeth and bones, photosensitivity, vaginal candidiasis, Gastric upset, Enterocolitis, Maculopapular rash, Other effects, pass through milk, tetrogenic.
aminoglycosides s/e (amine is bad for my ear)
nephrotoxicity and ototoxicity
quinolone s/e (quinn not a QT going to the grave, she has tendonitis)
prolonged QTs, bacterial overgrowth, dysrythmias, tendon rupture, tendonitis, neuropathy, seizures, myasthenia gravis. Watch for gait.
quinolone drug interactions (quin needs tums)
antacids, calcium, mg, iron, zinc. Take 1 hour before or after.
Xofluza - name and for what? (xo in A and B bali)
baloxavir marboxil
xofluza - when to take and what ages? (xiola is 12 yrs old)
Should be taken only in the first 2 days
after symptoms such as fever, aches &
sniffles appear
For use only in those aged 12 or more
adherence
collaboration and active role btwn patient and provider
antiretroviral
antiviral drugs that work against retroviruses like HIV
assembly
The stage of replication during which all the structural components come together at one site in the cell and the basic structure of the virus particle is formed.
budding
Budding enables viruses to exit the host cell and is mostly used by enveloped viruses.
The immature virus pushes out of the infected cell in a process called “budding.”
CCR5 antagonists
They mask the CCR5 binding site so the virus doesn’t see it and can’t enter.
bind to the CCR5 chemokine coreceptor on host cells, inducing a conformational change that impedes CCR5 interaction with HIV gp120, thereby preventing HIV entry into host cells.
CD4+T - what do they do?
The CD4+T cells carry out multiple functions, ranging from activation of the cells of the innate immune system, B-lymphocytes, cytotoxic T cells, as well as nonimmune cells, and also play critical role in the suppression of immune reaction
entry inhibitors
Entry inhibitors work by attaching themselves to proteins on the surface of CD4 cells or proteins on the surface of HIV. In order for HIV to bind to CD4 cells, the proteins on HIV’s outer coat must bind to the proteins on the surface of CD4 cells. Entry inhibitors prevent this from happening.
highly active antiretroviral therapy
(HAART)
combo of anti-retroviral drug cocktails - standard for HIV. control viral load, delaying or preventing the onset of symptoms or progression to AIDS, thereby prolonging survival in people infected with HIV.
Reverse transcriptase
RNA is turned into DNA.
DNA polymerase enzyme that transcribes single-stranded RNA into DNA. reverse of usual process. This is what HIV does.
integrase (integrate virus)
enzyme that promotes viral DNA into host DNA
integrase inhibitors
antiretroviral drug designed to block the action of integrase
non nucleoside analogues used to treat what? (no nukes for Art)
used to treat HIV as part of antiretroviral therapy (ART). ARVs interfere with the ability of a virus to multiply or reproduce.
nucleoside analogues
mimic endogenous nucleosides, exploiting cellular metabolism and becoming incorporated into both DNA and RNA. This property makes nucleoside analogues effective at inhibiting viral replication
postexposure prophylaxis (PEP) - how quickly should you take it and for how long? And what treatment? (Ralt is true to pep)
means taking medicine to prevent HIV after a possible exposure. PEP should be used only in emergency situations and must be started within 72 hours - for 28 days - after a recent possible exposure to HIV.
protease and HAART - (always has on NRTI)
a large group of enzymes that catalyze the hydrolysis of peptide bonds in proteins and polypeptides.
two or three NRTIs; two NRTIs plus one or two protease inhibitors; or a NRTI plus a NNRTI with one or two protease inhibitors
protease inhibitors (Tease HIV, tease hump)
It is one of the 5 classes of antiretroviral drugs. It works by inhibiting the HIV and protease retroviral enzymes that cleaves protein. . inhibit the cleavage of the polyprotein into functional proteins are called protease inhibitors. Protease is a protein-based enzyme that normally breaks the polyprotein into functional proteins, so blocking, or inhibiting, protease prevents this essential step of viral reproduction
reverse transcriptase inhibitors
block reverse transcriptase (an HIV enzyme). HIV uses reverse transcriptase to convert its RNA into DNA (reverse transcription). Blocking reverse transcriptase and reverse transcription prevents HIV from replicating.
amantadine (A for amantadine. aman symmetrical)
Symmetrel®- influenza A, onset within 48 hours. can be used in children, but cannot use in children less than 12 months.
rimantadine (A rim is good for kids)
Flumadine - influenza A -can be used in children.
zanamivir, oseltamivir (A Bee in Zanzebar)
Oseltamivir (Tamiflu®) and Zanamivir (Relenza®) - influenza A and B
amantadine best practices (Aman brushes her teeth..) narrow or wide?
Narrow. good oral care, causes dry mouth, monitor BP, ortho hypo, use large vein to avoid irritation. not for patients w/ exzema.
ramantadine best practices
same an amantadine but less side effects, less dizziness. can be used in children.
zanamivir, oseltamivir best practices - how fast to take it and what does it do? (zanzebar was my bud for 2 days)
stops budding. n/v. treatment needs to begin w/in 2 days.
CMV treatment (gang of cmv)
Ganciclovir (Cytovene®) and citofovir , foscarnet. Ganciclovir - Ophthalmic form surgically implanted
CMV (CMV not just HIV)
inflammation of retina can cause blindness. HHV 5 herpes.
allergic reaction
vancomycin - + or -? And treats what? (in the van w/ portable)
fights gram positive. treats c diff and staph.
MRSA treatment of choice (MRSA LOVES van)
vancomycin
vancomycin s/e (red man has bad ears)
nephrotoxicity and ototoxicity. red man syndrome and severe hypotension (infused too rapidly)
how fast to infuse vancomycin?
no faster than 60 minutes
vancomycin peak
18 - 50 mcg/mL
vancomycin trough (van is low at 10-20)
10 - 20 mcg/mL - only trough levels are monitored
vancomycin peak time
1 hour
vancomycin blood draws when?
immediately before next dose - you have 30 min leeway
best antibiotic for pneumonia gram + infection (ceph is best for +)
1st generation cephalosporin
cephalosporin 1st generation (the 1st generation is always positive)
Good gram-positive coverage Poor gram-negative coverage Parenteral and PO forms
Examples
cefadroxil (Duricef®, Ultracef®) cephradine (Velosef®)
cefazolin
cephalexin (Keflex®)
cephalosporins 1st generation used for (1st generation good at prevention)
Used for surgical prophylaxis, and for susceptible staphylococcal infections
cefazolin (Ancef® and Kefzol®): IV or IM cephalexin (Keflex ®): PO
cephalosporin 2nd generation (2nd generation only notable for anaerobic)
only generation w/ anaerobic coverage . Good gram-positive coverage
Better gram-negative coverage than first generation Examples:
cefaclor (Ceclor ®) cefprozil (Cefzil ®) cefoxitin (Mefoxin ®) cefuroxime (Zinacef ®) cefotetan (Cefotan) ®
ceph 2nd generation cefoxitin (the 2nd fox in my stomach)
abdominal and colorectal surgeries. kills anaerobes
ceph 2nd generation - cefuroxime (2nd fur prevents cold)
surgical prophylaxis, does not kill anaerobes
cephalosporins 3rd generation (3rd generation is def negative)
Most potent group against gram-negative bacteria Less active against gram-positive bacteria
Examples
cefotaxime (Claforan®) ceftazidime (Fortaz®) cefdinir (Omnicef®) ceftizoxime (Cefizox®) ceftriaxone (Rocephin®)
cephalo 3rd generation - ceftriaxone (3rd generation tria can get into your brain)
elimination is hepatic. easily passes meninges and diffuses into CSF to treat CNS infections
cephalo 3rd generation - ceftazidime (taz is negative spaz, but he likes pseudos)
excellent gram negative, used for difficult to treat, like pseudomonas. excellent spectrum coverage. resistance is limiting it’s usefullness.
cephalosporins 4th generation (4th generation is everywhere, and esp positive)
Broader spectrum of antibacterial activity than third generation, especially against gram-positive bacteria
Uncomplicated and complicated UTI cefepime (Maxipime®)
cephalosporin 5th generation - ceftaroline - only thing 5th generation ever did…
ceftaroline (Teflaro®)
Broader spectrum of antibacterial activity Effective against a wide variety of organisms
only cephalosprin approved for MRSA
cephalosporins adverse effects - inteacts with just one thing…
cross-sensitivity with penicillin if true allergy exists. n/v. diarrhea.
Retrovirus
uses RNA for genetic material
window period HIV
6 wks to 3 months
during window period - and is test + or - ?
No symptoms or signs of illness
HIV test is negative during Window Period
Virus is multiplying rapidly - viral load is high
person is VERY infectious
primary goal HIV window period
Primary Goal= viral load < 50 Copies/mL- considered undetectable
seroconversion - and when does it happen?
point at which HIV test becomes positive. Happens about 3 months after infection.
HIV asymptomatic period - think
Duration variable: < 1 year to > 15 years. The CD4 count is above 500 cells/mL
CD4 below 200
CD4 below2 00 = palative Treatment
CDC levels for CD4-T cells
500 - 1600: normal
200 - 500: beginning of HIV illness
< 200: AIDS
infection rate for practitioner to contract HIV and for 28 days
Pooled analysis of prospective studies on health care workers with occupational exposures suggests risk is approximately 0.3% (95% CI, 0.2% - 0.5%)1 within 72 hours of exposure for 28 DAYS- last 2 weeks kills any that might have slipped into a cell
Nevirapine classification (Nev is NN-ervring but not competitive)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Nevirapine s/e - hiv (Nev with an itchy liver)
rash-fever-n/HA- abn liver function. risk is greater in first 18 wks of treatment.
Fuzeon (and used with what?)
prevents vial cell attaching to cells. always used with other HIV drugs.
fuzeon - major side effect - hiv
SQ - everyone has an injection site irritation. can have allergic reactions, pneumonia.
Efavirenz s/e - hiv (fav bridge)
mental health - suicide, liver and skin reactions.
What is the rationale for HIV/AIDS pts to understand and know each med they are taking and why it will not cure them but keep their viral loads manageable
need to suppress viral load.
goals for HIV therapy
A. The viral load is undetectable.
B. The CD4+ count is as low as possible. C. Secondary infection does not occur. D. Medication regimen is adhered to.
Can antiviral drugs kill both healthy and cancer cells
Yes. often harms healthy cells bc they can only inhibit development and some of the proteins overlap with healthy cells. can kill herpes that leads to cancer - Kaposi - check this
Antineoplastic meds - what is important? (cancer needs water)
hydration important to prevent nephrotoxicity
pregnant women can’t take which anti-viral? (pregnant women can’t have viral ribs)
Ribavirin (Virazole®) - teratogenic -
best med for herpes simplex? (think)
acylcovir. synthetic necleoside analog. blocks cellular %. used to suppress replication of HSV-1, HSV-2, VZV.
HIV transmission - how?
sexualactivity,intravenousdruguse, perinatally from mother to child
HSV1 treatment - can it cure?
can’t cure but can speed up remission and reduce painful symptoms
What medication is used for Ocular implant and how susceptible of contracting is it?
Ganciclovir (Cytovene) - HIV and transplant
pt education for cancer drugs - physical, oral care, and diet - avoid what foods?
Comprehensive Physical assessment, Oral care education, Dietary education- to avoid spicy-acidic-alcohol & tobacco
PI - primary immunodeficiencies (it’s primarily genetics)
Primary immunodeficiencies are the result of genetic defects, and secondary immunodeficiencies are caused by environmental factors, such as HIV/AIDS or malnutrition.
What medication is used for Ocular implant and how susceptible of contracting is it?
Rationale use of Hormone Therapy
hormones increase cancer
Targeted Drug Therapy
danger of giving an Vinca alkaloid drug intrathecally (Vin is fatal)
vincristine is nearly always fatal and associated with an irreversible, painful ascending paralysis.
health care associated infections also known as (no illiana in health care)
nosocomial and iatrogenic
empiric, definitive, and prophylactic
empric - before culture has been identified.
proph - prevents infection, abdominal surgery.
bacteriostatic
inhibits growth rather than killing immediately
sulfas + or -?
+ and -
pneymocystis jirovecii pneumonia - what drug? (jovi sulfur face)
sulfa
Penicillinase
Penicillinase-resistant penicillins? a type of penicillin?
bacterial strain exposed to penicillin may produce an extracellular enzyme called penicillinase which leaves the bacterial cell and degrades the penicillin around it
penicillin - how does it work? and + or -?
enter via cell wall, bind to penicillin-protein, cell wall distrupted. gram +
cephalsporins - killer ceph
bacteracidal
carbapenems - what for? (carbs are complicated connective tissue)
Reserved for complicated body cavity and connective
tissue infections in acutely ill hospitalized patients.
tetracycline - positive or neg? (tet in the hot tub with sulfa)
both.
superinfection from which drug?
tetra, aminoglycoside
what to take with all antibiotics?
at least 6 to 8 ounces of water
sulfa take with how much water over 24 hrs?
Take with 2000 to 3000 mL
of fluid/24 hr
how long to monitor pt for penicillin reaction
at least 30 min
aminoglycosides - + or -? And kills what?
kill gram -. some +, but mostly -.
how to administer aminoglycosides?
parenterally, only one is given orally.
linzoid - don’t take with…(linz and tyrine don’t get along, he gives her SS)
Linz is just an antibiotic. tyramine-containing foods, seratonin syndrome
what to take for protozoa infection? (your old friend)
metronidazole
nitrofurantoin (Macrodantin®) good for…(my bladder is on nitro)
UTI, Drug concentrates in the urine
Ledipasvir/Sofosbuvir (Harvoni) Hep C - what issue? (lead sofas cost a lot for hep c patients)
Can be Cost Prohibitive
anti-retroviruses - what to monitor for? (anti-retroviruses like opportunities)
opportunistic diseases
HAART typical results
Decreased viral load to undetectable levels (<50
Copies/mL)
Improved CD4+ T cell count (>500/mm3)
protease inhibitors suffix (tease tel aviv) and used for WHAT?
protease enzyme that cleaves protein - opinavir/ritonavir (Kaletra®), atazanavir (Reyataz®),
fosamprenavir (Lexiva®), etc.
Cancerous cells do not have
Growth control mechanisms
Positive physiologic function
cell-cycle specific drugs used for what?
drugs act during multiple phases of the cell cycle - anti-tumor
cell-cycle non-specific drugs
Cytotoxic during any cell-cycle stage
infiltration (the meds infiltrated my tissue)
When a non - vesicant solution or medication is introduced to the tissue surrounding the IV catheter
Methotrexate (cancer) is also used to treat (meth for cancer, psor, and arthritis)
severe cases of psoriasis and rheumatoid arthritis
antimetabolites adverse affects (anti- feet)
palmar-plantar - hand foot, n/v myleosuppression, hair loss, tumor lysis
mitotic inhibitors (cancer) adverse effects (mite you be extravagant)
Extravasation